Krisis Tiroid Pascakraniotomi Mikro pada Makroadenoma Hipofise disertai Akromegali

Abstract

Tumor Hipofise sering terjadi pada dewasa dan mewakili 10% tumor intrakranial. Akromegali adalah sindrom klinik yang disebabkan oleh produksi hormon pertumbuhan yang berlebihan dan diketahui sebagai penyakit yang jarang, yang ditandai oleh sekresi yang berlebihan hormon pertumbuhan (GH, growth hormone) dan faktor pertumbuhan seperti insulin (IGF-1/Insulin Growth Factor-1). Insiden keseluruhan akromegali diperkirakan mencapai 3 sampai 5 kasus baru per juta populasi. Akromegali dapat muncul bersamaan dengan gangguan tiroid. Lini pertama pengobatan untuk akromegali adalah operasi transsphenoidal. Manajemen perioperatif operasi hipofise membutuhkan penanganan oleh tim bedah saraf, neuroanaesthesiologists dan ahli endokrin. Semua pasien dengan adenoma hipofise memerlukan evaluasi endokrin menyeluruh pada periode pre-operatif dan di follow-up saat periode post-operatif. Seorang wanita 50 tahun masuk Rumah Sakit dengan keluhan kedua tangan dan kaki membesar, telapak kaki menebal dan bengkok, rahang dan hidung membesar. Riwayat pengobatan hipertiroid ± 3 tahun. Dari pemeriksaan magnetic resonance imaging (MRI) kepala dengan kontras didapatkan makroadenoma hipofise. Pasien menjalani prosedur operasi craniotomi mikro transsphenoidal. Pasca operasi pasien dirawat di ICU dan mengalami perburukan dan pada akhirnya meninggal di hari kedua perawatan ICU oleh karena krisis tiroid.

Thyroid Crisis Post Microcraniotomy of Macroadenoma Pituitary Accompanied Acromegaly

Pituitary tumors are common in adults and represents 10% of intracranial tumors. Acromegaly is a clinical syndrome caused by the production of excess growth hormone and it is known as a rare disease, which is characterized by excessive secretion of growth hormone (GH) and growth factors such as insulin (IGF-1, Insulin Growth Factor-1). The overall incidence of acromegaly is estimated at 3 to 5 new cases per million population. Acromegaly can coexist with thyroid disorders. First-line treatment for acromegaly is transsphenoidal surgery. Perioperative management of pituitary surgery requires treatment by a team of neurosurgeons, neuroanaesthesiologists and endocrinologists. All patients with pituitary adenoma requires a thorough pre -operative endocrine evaluation and a follow- up in post- operative period. A 50 years old woman entered a hospital with complaints of swollen both hands and feet, thicken and crooked foot, enlarging of jaw and nose. She had a history of ± 3 years hyperthyroid treatment. Magnetic resonance imaging (MRI) examination of the head with the contrast obtained macroadenoma pituitary. Patiens underwent micro- surgery procedures of craniotomi transsphenoidal. Post-surgery, Patient being observed in the ICU and her condition was deteriorated and she eventually died on the second day due to thyroid crisis.